Wolf Counseling

MBCT Questionnaire

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Thank you for your response!

Thank you — I’ll be in touch as soon as possible!

General Questions

What interests you about MBCT?

Why might you choose to take this class at this time?

When you are feeling stressed, anxious, depressed, or overwhelmed, what do you typically do?

Do you have any experience(s) with mindfulness?

Have you had any yoga or formal meditation practice? (e.g., sitting, walking meditation, Samatha, Vipassana, Metta, etc.)

Are you currently experiencing any level of depression or anxiety? If so, how does it compare to the past?

Do you generally feel supported in your life? What kinds of support are there? (e.g., friends, family, therapist, medical providers, community-based supports, etc).

Do you think this is the time to attend? (2.5 hour class weekly; with an optional 6-hour ‘all day’ session; and upwards of 25-45 min/day for your own practice?

Any concerns or questions you’d like to ask?

Is there anything you would like to share which may be important for me to know, so I can best support you in participating in this class?

Schedule Selection

Please Note: all possible scheduled classes include an “All day” (8-hour event), which you can choose to attend either Saturday 8/15 or Sunday 8/16, from 9-5pm.

Online, Synchronous, Mondays, 10 Aug – 28 Sept 2026 (2-4:30pm)

Online, Synchronous, Wednesdays, 12 Aug – 30 Sept 2026 (9-11:30am)

In-Person, Wauregan CT, Thursdays, 13 Aug – 01 Oct 2026 (2-4:30pm)

Online, Synchronous, Fridays, 14 Aug – 02 Oct 2026 (8:30am-11am)

Contact Info

Name

Pronouns

Phone number

Preferred method(s) of communication:

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